Tag: nevin manimala

J Craniofac Surg. 2023 Nov 27. doi: 10.1097/SCS.0000000000009867. Online ahead of print.

ABSTRACT

Microtia is a congenital malformation of the external ear that often presents with other anatomical abnormalities and ipsilateral hearing loss (HL). The aim of this study was to present the correlation among important phenotypic abnormalities in microtia and their relationship with HL in a clinical population in China. In this study, a retrospective analysis was conducted on 307 patients diagnosed with microtia who visited the Department of Auricular Reconstruction of the Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, for surgical auricle reconstruction from April 2021 to April 2022. Standardized classification of ear malformations, craniofacial CT scans, and pure tone audiometric data were collected, and statistical analyses were performed using the rank sum test, Kruskal-Wallis test, and Spearman’s rank correlation coefficient. The results showed that group differences between ear malformation and variations in the development of mandible, external auditory canal (EAC), and mastoid pneumatization were statistically significant and each had a positive correlation. Among them, the correlation between development of ear and EAC was the most significant (Ρ=0.72). Besides, the severity of HL (97% were conductive) was positively correlated with ear and EAC dysplasia with or without mandibular hypoplasia. Based on the statistical analysis of the correlation between ear malformation and HL, the authors strongly recommend that facial phenotype reconstruction and hearing improvement of microtia should be considered comprehensively, regardless of whether children with microtia show HL or not, early diagnosis of audiology evaluation and appropriate intervention measures should be implemented.

PMID:38011621 | DOI:10.1097/SCS.0000000000009867

Rev Med Inst Mex Seguro Soc. 2023 Sep 18;61(Suppl 2):S155-S160.

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) can cause cardiac injury, probably associated with myocarditis and ischemia induced by the infection. Myocardial damage leads to the liberation of proinflammatory cytokines and to the activation of autoimmune adaptive mechanisms through molecular limitation.

OBJECTIVE: To assess mortality associated with myocardial damage in hospitalized patients with COVID-19 confirmed by troponin I measurement.

MATERIAL AND METHODS: Case-control study nested in a cohort of patients of a third-level hospital. Descriptive statistics were used to characterize the population. Qualitative variables were expressed as proportions and ranges, quantitative variables as means and standard deviation. Fisher’s exact test was used to compare mortality between patients with and without myocardial damage. A p value < 0.05 was considered significant.

RESULTS: From June 2020 to August 2020, 28 patients who met the selection criteria were enrolled, out of which 15 had no myocardial damage and 13 had myocardial damage assessed by serum troponin measurement. A strong association was found between mortality and the presence of myocardial damage, since mortality was 20% (3/15) among patients without myocardial damage and 92.3% (12/13) among those with myocardial damage (Fisher’s exact test, p < 0.005).

CONCLUSION: Mortality in patients with COVID-19 is associated with myocardial damage assessed by troponin I measurement.

PMID:38011615

Rev Med Inst Mex Seguro Soc. 2023 Sep 18;61(Suppl 2):S141-S147.

ABSTRACT

BACKGROUND: Women across the globe are at risk of physical or sexual abuse by an intimate partner or other offender. Violence against women can lead to physical injuries, impaired mental health, and specific chronic diseases. In some cases, such types of violence can even result in disability or death for some victims.

OBJETIVE: To identify the factors that cause domestic violence in women of Guanajuato.

MATERIAL AND METHODS: Prospective, observational, analytical and cross-sectional study. 325 patients of 18 years or older who were literate and visited a third level hospital were included. The Scale of Violence in Couple Relations with a Likert-type response was administered. Data were analyzed by descriptive statistics. Frequencies and percentages of all variables, chi-square test, and bivariate analysis were used.

RESULTS: Of 325 women of 36 (30-46) years of age, 214 (65.8%) were married. The majority were high school graduates, 152 (46.8%). 52% of women reported having experienced domestic violence at least once. Knowing the existence of a domestic violence protection law produced an OR 0.34 (0.20-0.57), p-0.001 and knowing the meaning of domestic violence gave an OR 0.35 (0.21-0.58 ), p<0.001.

CONCLUSIONS: A high percentage of women reported having experienced domestic violence at least once. The determinants of violence were similar in women with and without exposure to it. Protective factors were knowledge of the law and the meaning of domestic violence.

PMID:38011591

Med Phys. 2023 Nov 27. doi: 10.1002/mp.16847. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: Magnetic resonance imaging (MRI)-based synthetic computed tomography (sCT) simplifies radiation therapy treatment planning by eliminating the need for CT simulation and error-prone image registration, ultimately reducing patient radiation dose and setup uncertainty. In this work, we propose a MRI-to-CT transformer-based improved denoising diffusion probabilistic model (MC-IDDPM) to translate MRI into high-quality sCT to facilitate radiation treatment planning.

METHODS: MC-IDDPM implements diffusion processes with a shifted-window transformer network to generate sCT from MRI. The proposed model consists of two processes: a forward process, which involves adding Gaussian noise to real CT scans to create noisy images, and a reverse process, in which a shifted-window transformer V-net (Swin-Vnet) denoises the noisy CT scans conditioned on the MRI from the same patient to produce noise-free CT scans. With an optimally trained Swin-Vnet, the reverse diffusion process was used to generate noise-free sCT scans matching MRI anatomy. We evaluated the proposed method by generating sCT from MRI on an institutional brain dataset and an institutional prostate dataset. Quantitative evaluations were conducted using several metrics, including Mean Absolute Error (MAE), Peak Signal-to-Noise Ratio (PSNR), Multi-scale Structure Similarity Index (SSIM), and Normalized Cross Correlation (NCC). Dosimetry analyses were also performed, including comparisons of mean dose and target dose coverages for 95% and 99%.

RESULTS: MC-IDDPM generated brain sCTs with state-of-the-art quantitative results with MAE 48.825 ± 21.491 HU, PSNR 26.491 ± 2.814 dB, SSIM 0.947 ± 0.032, and NCC 0.976 ± 0.019. For the prostate dataset: MAE 55.124 ± 9.414 HU, PSNR 28.708 ± 2.112 dB, SSIM 0.878 ± 0.040, and NCC 0.940 ± 0.039. MC-IDDPM demonstrates a statistically significant improvement (with p < 0.05) in most metrics when compared to competing networks, for both brain and prostate synthetic CT. Dosimetry analyses indicated that the target dose coverage differences by using CT and sCT were within ± 0.34%.

CONCLUSIONS: We have developed and validated a novel approach for generating CT images from routine MRIs using a transformer-based improved DDPM. This model effectively captures the complex relationship between CT and MRI images, allowing for robust and high-quality synthetic CT images to be generated in a matter of minutes. This approach has the potential to greatly simplify the treatment planning process for radiation therapy by eliminating the need for additional CT scans, reducing the amount of time patients spend in treatment planning, and enhancing the accuracy of treatment delivery.

PMID:38011588 | DOI:10.1002/mp.16847

Alzheimers Dement. 2023 Nov 27. doi: 10.1002/alz.13485. Online ahead of print.

ABSTRACT

INTRODUCTION: Protein-based plasma assays provide hope for improving accessibility and specificity of molecular diagnostics to diagnose dementia.

METHODS: Plasma was obtained from participants (N = 837) in our community-based University of Kentucky Alzheimer’s Disease Research Center cohort. We evaluated six Alzheimer’s disease (AD)- and neurodegeneration-related (Aβ40, Aβ42, Aβ42/40, p-tau181, total tau, and NfLight) and five inflammatory biomarkers (TNF𝛼, IL6, IL8, IL10, and GFAP) using the SIMOA-based protein assay platform. Statistics were performed to assess correlations.

RESULTS: Our large cohort reflects previous plasma biomarker findings. Relationships between biomarkers to understand AD-inflammatory biomarker correlations showed significant associations between AD and inflammatory biomarkers suggesting peripheral inflammatory interactions with increasing AD pathology. Biomarker associations parsed out by clinical diagnosis (normal, MCI, and dementia) reveal changes in strength of the correlations across the cognitive continuum.

DISCUSSION: Unique AD-inflammatory biomarker correlations in a community-based cohort reveal a new avenue for utilizing plasma-based biomarkers in the assessment of AD and related dementias.

HIGHLIGHTS: Large community cohorts studying sex, age, and APOE genotype effects on biomarkers are few. It is unknown how biomarker-biomarker associations vary through aging and dementia. Six AD (Aβ40, Aβ42, Aβ42/40, p-tau181, total tau, and NfLight) and five inflammatory biomarkers (TNFα, IL6, IL8, IL10, and GFAP) were used to examine associations between biomarkers. Plasma biomarkers suggesting increasing cerebral AD pathology corresponded to increases in peripheral inflammatory markers, both pro-inflammatory and anti-inflammatory. Strength of correlations, between pairs of classic AD and inflammatory plasma biomarker, changes throughout cognitive progression to dementia.

PMID:38011580 | DOI:10.1002/alz.13485

Med Phys. 2023 Nov 27. doi: 10.1002/mp.16841. Online ahead of print.

ABSTRACT

BACKGROUND: Photon counting detectors (PCDs) for x-ray computed tomography (CT) face spectral distortion from pulse pileup and charge sharing. The photon counting scheme used by many PCDs is threshold-subtract (TS) with pulse height analysis (PHA), where each counter counts up-crossing events when pulses exceed an energy threshold. PCD data are not Poisson-distributed due to charge sharing and pulse pileup, but the counting statistics have never been studied yet.

PURPOSE: The objectives of this study were (1) to propose a modified photon counting scheme, direct energy binning (DB), that is expected to be robust against pulse pileup; (2) to assess the performance of DB compared to TS; and (3) to evaluate its counting statistics.

METHODS: With DB scheme, counter k starts a timer upon an up-crossing event of energy threshold k, and adds a count only if the next higher energy threshold (k+1) was not crossed within a short time window (hence, the pulse peak belongs to the energy bin k). We used Monte Carlo (MC) simulation and assessed count-rate curves and count-rate-dependent spectral imaging task performance for conventional CT imaging as well as water thickness estimation, water-bone material decomposition, and K-edge imaging with tungsten as the K-edge material. We also assessed count-rate-dependent measurement statistics such as expectation, variance, and covariance of total counts as well as energy bin outputs. The agreement with counting statistics models was also evaluated.

RESULTS: The DB scheme improved the count-rate curve, that is, mean measured counts as a function of input count-rate, and peaked with 59% higher count-rate capability than the TS scheme (3.5 × 10⁸ counts per second (cps)/mm² versus 2.3 × 10⁸ cps/mm² ). The Cramér-Rao lower bounds (CRLB) of the variance of basis line integrals estimation for DB was better than those for TS by 2% for the conventional CT imaging, 30% for water-bone material decomposition, and 32% for K-edge imaging at 1000 mA (at 7.3 × 10⁷ cps/sub-pixel after charge sharing). When count-rates were lower, PCD data statistics were dominated by charge sharing: the variance of total counts and lower energy bins was larger than the mean counts; the covariance of bin data was positive and non-zero. When count-rates were higher, PCD data statistics were dominated by pulse pileup: the variance of data was lower than the mean; the covariance of bin data was negative. The transition between the two regimes occurred smoothly, and pulse pileup dominated the statistics ≥400 mA (when the count-rate after charge sharing was 2.9 × 10⁷ cps/sub-pixel and the probability of count-loss for DB was 37%). Both DB and TS had good agreement with Yu-Fessler’s models of total counts; however, DB had a better agreement with Wang’s variance and covariance models for energy bin data than TS did.

CONCLUSIONS: The proposed DB scheme had several advantages over TS. At low to moderate flux, DB could improve the resilience of PCDs to pulse pileup. Counting statistics deviated from the Poisson distribution due to charge sharing for lower count-rate conditions and pulse pileup for higher count-rate conditions.

PMID:38011545 | DOI:10.1002/mp.16841

Curr J Neurol. 2021 Oct 7;20(4):229-234. doi: 10.18502/cjn.v20i4.8349.

ABSTRACT

Background: Atherosclerotic involvement of large and small cerebral arteries leading to infarction is among the most prevalent subtypes of stroke worldwide. The hemodynamic changes due to these arterial pathologies can be studied non-invasively and in real-time by using transcranial Doppler (TCD) techniques. TCD indices of the studied arteries may guide the clinician in differentiating these two underlying arterial pathologies. Methods: A cross-sectional study of patients with small and large vessel types of cerebral infraction based on the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) stroke classification was undertaken in the inpatient population of neurology service of Razi Hospital, Tabriz, Iran, from October 2018 to October 2019. After clinical diagnosis, all cases underwent TCD studies, brain magnetic resonance imaging (MRI), and brain and cervical four-vessel magnetic resonance angiography (MRA). The results of TCD indices related to major arteries of the circle of Willis were tabulated and compared between large and small vessel subtypes of cerebral infarction. Results: A statistically significant difference between right middle cerebral artery (MCA) pulsatility index (PI), left MCA PI, right internal carotid artery (ICA) PI, end-diastolic velocity (EDV), left ICA PI, left ICA EDV, left anterior cerebral artery (ACA) PI, and right vertebral artery (VA) PI measures of the two groups was seen (P < 0.05). In comparison to the large vessel group, left ACA, right VA, and bilateral MCAs and ICAs in the small-vessel stroke group demonstrated an elevated PI. Conclusion: A significant increase of PI occurs in the majority of intracranial arteries of patients with small vessel stroke. This makes PI a valuable marker for differentiating strokes with different underlying pathophysiologies.

PMID:38011485 | PMC:PMC9107575 | DOI:10.18502/cjn.v20i4.8349

Curr J Neurol. 2021 Oct 7;20(4):202-207. doi: 10.18502/cjn.v20i4.8345.

ABSTRACT

Background: One intriguing aspect of stroke is its higher incidence in men as compared to women. Endogenous sex hormones, testosterone and estradiol, may be responsible for this difference. This research aims to study serum testosterone and estradiol levels in men with acute ischemic stroke (AIS) and to correlate these levels with National Institutes of Health Stroke Scale (NIHSS) score and infarct size in computed tomography (CT). Methods: 100 male patients with AIS and 100 age-matched controls were included in this case-control study. Patients with hemorrhagic stroke, taking hormonal preparations, or suffering from chronic illnesses like tuberculosis (TB), cancer, etc. were excluded. Complete history was obtained including presence of established risk factors and physical examination was done in cases and controls with informed written consent. Severity of stroke in cases was assessed by the NIHSS. CT scan of brain was performed within 72 hours of patient’s admission to hospital. The infarct size was measured in centimeters as the largest visible diameter of the infarct on CT scan. Fasting blood samples were obtained for routine investigations and estimating estradiol and testosterone levels. Results: Mean total testosterone level in cases (223.30 ± 143.44 ng/dl) was significantly lower than that of controls (515.34 ± 172.11 ng/dl) (P < 0.001), while estradiol levels had no significant statistical difference (P = 0.260). A significant inverse correlation was found between total testosterone levels and stroke severity (r = -0.581, P < 0.001) and also, total testosterone levels and infarct size (r = -0.557, P < 0.001). Estradiol levels in patients had no significant correlation with stroke severity (P = 0.618) or infarct size (P = 0.463). Conclusion: Low testosterone levels are associated with increased stroke severity and infarct size in men. Further studies are required to establish whether low testosterone is a cause or effect of ischemic stroke and also to explore the potential benefits of testosterone supplementation in men with AIS.

PMID:38011460 | PMC:PMC9107573 | DOI:10.18502/cjn.v20i4.8345

Curr J Neurol. 2020 Jul 5;19(3):146-149. doi: 10.18502/cjn.v19i3.5428.

ABSTRACT

Background: Optic neuritis (ON) is a common visual sign in multiple sclerosis (MS). Although ON is recovered in most cases, other visual functions such as visual perception are affected and are not fully recovered. The aim of this study is to investigate the relationship between visual evoked potential (VEP) P100 and N70 latencies and visual perception using the Developmental Test of Visual Perception-Adolescent and Adult (DTVP-A) in people with MS. Methods: In this cross-sectional study, 24 people with ON due to MS, aged 18-50 years old took part. In order to assess the visual perception and optic nerve conductivity, the DTVP-A and the VEP were accomplished, respectively. Pearson’s product-moment correlation coefficient was used to analyze the data. Results: There was a significant negative correlation between right VEP P100 latency and total score of DTVP-A (r = -0.450, P < 0.05) as well as a significant negative correlation between right VEP P100 latency with visual-motor integration (VMI) subtest of DTVP-A (r = -0.485, P < 0.05). Conclusion: The visual perception has an important role in safety and independent daily activities. Therefore, determining the related factors is essential. Although the findings of the current study revealed a moderate statistical correlation between visual perception and right VEP P100 latency, the small sample size might limit the generalization of our findings; therefore, further study is required to confirm our results.

PMID:38011459 | PMC:PMC8185592 | DOI:10.18502/cjn.v19i3.5428

Curr J Neurol. 2022 Apr 4;21(2):98-104. doi: 10.18502/cjn.v21i2.10493.

ABSTRACT

Background: Swallowing is one of the most complex functions of the central nervous system (CNS), which is controlled by different parts of the brain. Oropharyngeal dysphagia (OD) is one of the most common complications after stroke. Despite a variety of behavioral, compensatory, and rehabilitative methods, many stroke patients still suffer from swallowing disorders that adversely affect their quality of life (QOL). The aim of this study was to evaluate the effect of pyridostigmine on patients with post-stroke dysphagia. Methods: A randomized, double-blind, placebo-controlled clinical trial was carried out on 40 patients suffering from post-stroke dysphagia. Patients were assigned randomly into two groups: intervention and control groups (20 in each group). The intervention group was treated with pyridostigmine (60 mg, three times a day, 30 minutes before each meal for three weeks), and the control group received placebo treatment in the same way. All patients (intervention and control) were evaluated according to National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and Functional Communication Measures (FCM)/American Speech-Language-Hearing Association (ASHA) criteria at baseline and after three weeks of intervention. Values of P < 0.05 were considered statistically significant. Results: In the intervention group, the mean values of NIHSS, mRS, and ASHA/FCM were significantly reduced following three weeks of treatment with pyridostigmine (P = 0.002, P = 0.003, and P < 0.001, respectively), but no significant differences were found in the mean NIHSS, mRS, and ASHA/FCM in the placebo group. Conclusion: Although pyridogestamine is somewhat effective in post-stroke dysphagia, it has not been shown to be more important in preventing aspiration pneumonia and length of hospital stay.

PMID:38011458 | PMC:PMC9860206 | DOI:10.18502/cjn.v21i2.10493